Association between sleep quality and glycemic control among patients with type 2 diabetes mellitus: a cross-sectional study in a Thai primary care setting
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20260762Keywords:
Sleep quality, Glycemic control, Type 2 diabetes mellitus, Primary care, Blood pressure controlAbstract
Background: Sleep is a vital homeostatic process linked to circadian rhythms. Sleep deprivation or misalignment can impair insulin sensitivity; however, while studies in urban Thai settings exist, data in primary care remains limited and inconclusive. This cross-sectional study investigated the association between sleep quality and glycemic control among patients with type 2 diabetes mellitus (T2DM) at a primary care unit in Phra Nakhon Si Ayutthaya Hospital.
Methods: A total of 109 patients with T2DM were enrolled. Sleep quality was assessed using the Thai version of the Pittsburgh sleep quality index (PSQI). Data were analyzed using descriptive statistics and multiple logistic regression to identify independent predictors of glycemic and blood pressure control.
Results: Multiple logistic regression revealed no significant association between sleep quality and glycemic control (Adjusted OR=0.77; 95% CI: 0.35-1.71; p=0.523) or blood pressure control. However, insulin therapy was significantly associated with poor glycemic control (Adjusted OR=7.31; 95% CI: 1.33-40.15; p=0.022). Regarding blood pressure, female gender was a protective factor (Adjusted OR=0.19; p=0.003), while elevated body mass index (BMI) (Adjusted OR=3.76; p=0.034) and insulin use (Adjusted OR=4.72; p=0.049) were significant risk factors.
Conclusions: Sleep quality was not associated with glycemic or blood pressure control in T2DM patients in this primary care setting. Clinical management should prioritize other significant determinants, including gender, BMI, and insulin therapy, to optimize patient outcomes.
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References
World Health Organization. Noncommunicable diseases country profiles 2018. Geneva: World Health Organization. 2018. Available at: https://www.who.int/publications/i/item/ncd-country-profiles-2018. Accessed on 3 December 2025.
Reutrakul S, Van Cauter E. Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Ann N Y Acad Sci. 2014;1311:151-73. DOI: https://doi.org/10.1111/nyas.12355
Lou P, Zhang P, Zhang L, Chen P, Chang G, Zhang N, et al. Effects of sleep duration and sleep quality on prevalence of type 2 diabetes mellitus: a 5-year follow-up study in China. Diabetes Res Clin Pract. 2015;109:178-84. DOI: https://doi.org/10.1016/j.diabres.2015.04.012
World Health Organization. WHO technical meeting on sleep and health. Bonn: World Health Organization Regional Office for Europe; 2004. Available at: https://iris.who.int/handle/10665/ 349782. Accessed on 3 December 2025.
Sakamoto R, Yamakawa T, Takahashi K, Suzuki J, Shinoda MM, Sakamaki K, et al. Association of usual sleep quality and glycemic control in type 2 diabetes in Japanese: a cross sectional study. Sleep and Food Registry in Kanagawa (SOREKA). PLoS One. 2018;13(1):e0191771. DOI: https://doi.org/10.1371/journal.pone.0191771
Tang YZ, Meng LL, Li DQ, Min Y, Zhu YJ, Li CG, et al. Interaction of sleep quality and sleep duration on glycemic control in patients with type 2 diabetes mellitus. Chin Med J (Engl). 2014;127(19):3543-7. DOI: https://doi.org/10.3760/cma.j.issn.0366-6999.20141512
Kim BK, Kim BS, An SY, Lee MS, Choi YJ, Han SJ, et al. Sleep duration and glycemic control in patients with diabetes mellitus: Korea national health and nutrition examination survey 2007-2010. J Korean Med Sci. 2013;28(9):1334-9. DOI: https://doi.org/10.3346/jkms.2013.28.9.1334
Reutrakul S, Siwasaranond N, Nimitphong H, Saetung S, Chirakalwasan N, Ongphiphadhanakul B, et al. Relationships among sleep timing, sleep duration and glycemic control in Type 2 diabetes in Thailand. Chronobiol Int. 2015;32(10):1469-76. DOI: https://doi.org/10.3109/07420528.2015.1105812
Sitasuwan T, Bussaratid S, Ruttanaumpawan P, Chotinaiwattarakul W. Reliability and validity of the Thai version of the Pittsburgh Sleep Quality Index. J Med Assoc Thai. 2014;97(3):S57-67.
Tsai YW, Kann NH, Tung TH, Chao YJ, Lin CJ, Chang KC, et al. Impact of subjective sleep quality on glycemic control in type 2 diabetes mellitus. Fam Pract. 2012;29(1):30-5. DOI: https://doi.org/10.1093/fampra/cmr041
Textor J, Hardt J, Knüppel S. DAGitty: a graphical tool for analyzing causal diagrams. Epidemiology. 2011;22(5):745. DOI: https://doi.org/10.1097/EDE.0b013e318225c2be
Azharuddin M, Kapur P, Adil M, Ghosh P, Sharma M. The impact of sleep duration and sleep quality on glycaemic control in Asian population with type 2 diabetes mellitus: a systematic literature review and meta-analysis of observational studies. Clin Epidemiol Glob Health. 2020;8(3):967-75. DOI: https://doi.org/10.1016/j.cegh.2020.03.006
Lee SWH, Ng KY, Chin WK. The impact of sleep amount and sleep quality on glycemic control in type 2 diabetes: a systematic review and meta-analysis. Sleep Med Rev. 2017;31:91-101. DOI: https://doi.org/10.1016/j.smrv.2016.02.001
Haghighatpanah M, Nejad ASM, Haghighatpanah M, Thunga G, Mallayasamy S. Factors that correlate with poor glycemic control in type 2 diabetes mellitus patients with complications. Osong Public Health Res Perspect. 2018;9(4):167-74. DOI: https://doi.org/10.24171/j.phrp.2018.9.4.05
Zhu BQ, Li XM, Wang D, Yu XF. Sleep quality and its impact on glycaemic control in patients with type 2 diabetes mellitus. Int J Nurs Sci. 2014;1(3):260-5. DOI: https://doi.org/10.1016/j.ijnss.2014.05.020
Morris AB, Li J, Kroenke K, Bruner-England TE, Young JM, Murray MD. Factors associated with drug adherence and blood pressure control in patients with hypertension. Pharmacotherapy. 2006;26(4):483-92. DOI: https://doi.org/10.1592/phco.26.4.483
Stamler J. The INTERSALT Study: background, methods, findings, and implications. Am J Clin Nutr. 1997;65(2):626S-42S. DOI: https://doi.org/10.1093/ajcn/65.2.626S
Randeree HA, Omar MA, Motala AA, Seedat MA. Effect of insulin therapy on blood pressure in NIDDM patients with secondary failure. Diabetes Care. 1992;15(10):1258-63. DOI: https://doi.org/10.2337/diacare.15.10.1258
Lo K, Woo B, Wong M, Tam W. Subjective sleep quality, blood pressure, and hypertension: a meta-analysis. J Clin Hypertens (Greenwich). 2018;20(3):592-605. DOI: https://doi.org/10.1111/jch.13220